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General NPI Number Information
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NPI Number | 1134153083
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA ENT ALLERGY & SLEEP MEDICINE PA
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 15 EXCHANGE DR
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City | LUGOFF
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State | SC
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Zip | 29078-9198
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Country | US
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Telephone | 803-408-3277
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Fax | 803-408-3277
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Provider Business Mailing Address
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Address Line | PO BOX 520
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City | LUGOFF
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State | SC
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Zip | 29078-0520
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Country | US
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Telephone | 803-408-3277
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Fax | 803-408-3277
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Authorized Official
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Title or Position | CHIEF REVENUE OFFICER
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Name | PAMELA LEA KIRBY
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Credential |
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Telephone | 803-424-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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